Diagnosis of Fibromyalgia

By  , Expert Content
Jun 29, 2012

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Fibromyalgia is diagnosed based on clinical history and physical exam. There is no simple blood test or X-ray, which can diagnose fibromyalgia.

Physical exam: American College of Rheumatology (ACR) established two criteria for the diagnosis of fibromyalgia in 1990.  For fibromyalgia to be diagnosed, you must have muscle pain for longer than three months and tender points. Tender points are spots on the body that are hurt when subjected to pressure. They are present at specific sites on the body and according to ACR, there are 18 of these sensitive spots. Most of these are located on the neck and back. On application of pressure to the tender points, if you experience discomfort at 11 or more of these points, the physical exam is positive for fibromyalgia.

Tender points are located at the following sites:

  • Left or right side of the back of the neck (just below the hairline)
  • Left or right side of the front of the neck, (above the collarbone i.e the clavicle)
  • Left or right side of the chest, (just below the collarbone)
  • Left or right side of the upper back, (near where the neck and shoulder join)
  • Left or right side of the spine in the upper back between the shoulder blades (scapula)
  • Inside of the left or right arm where it bends at the elbow
  • Left or right side of the lower back, just below the waist
  • Right or left side of the buttocks below the hip bones
  • Right or left kneecap

The ACR guidelines are useful for researchers and studies on fibromyalgia, but clinically, they have limitations. Pain and other symptoms of fibromyalgia may come and go and it is not clear as to how much pressure has to be applied during a tender point exam. Therefore, less stringent guidelines have been developed for doctors for use in clinical practice. According to the new guidelines, newer diagnostic criteria include:

  • extensive pain in body lasting at least three months
  • no other underlying condition that may be causing the pain

Blood tests: Although, blood tests do not confirm a diagnosis of fibromyalgia, the doctor may recommend blood tests or X-rays to rule out illnesses that can cause similar symptoms. Some of the blood tests that may be done include:

  • complete blood count
  • Erythrocyte sedimentation rate
  • Thyroid function tests



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